Plastic surgery; its principles and practice . estore function completely, evenwhen all tension has been relieved. HAND Loss of Substance.—On the back of the hand the defect may becovered with skin grafts of any type, but preferably with large grafts,as the scarring is less noticeable. On the palm the only type of graftwhich promises permanent results is of whole-thickness. When thedestruction is deep, pedunculated flaps should be used on the dorsumor palm of the hand. A reasonably thick flap on either palm or dorsumin due time, will shrink and be very little thicker than the normal sur-roundi
Plastic surgery; its principles and practice . estore function completely, evenwhen all tension has been relieved. HAND Loss of Substance.—On the back of the hand the defect may becovered with skin grafts of any type, but preferably with large grafts,as the scarring is less noticeable. On the palm the only type of graftwhich promises permanent results is of whole-thickness. When thedestruction is deep, pedunculated flaps should be used on the dorsumor palm of the hand. A reasonably thick flap on either palm or dorsumin due time, will shrink and be very little thicker than the normal sur-rounding skin. Contractures.—These may vary in extent from that of any portionto complete involvement. The flexor type is the most common. Horrible deformities due to cicatricial contractures are found on SURGERY OF THE EXTREMITIES 657 the hand, and the effect of the distortion is unbelievable unless the contracture has been relieved, if skin grafting is decided on,only the whole-thickness graft should be considered, as recontraction. Pig. 773.—Contracture of all the fingers following severe infection treated by multipleincisions.—In this case the only method of treatment promising relief would be the implan-tation of a pedunculated flap into the palm and wrist. Then the lengthening or reconstruc-tion of the tendons. will often occur when other types are used. I have had good successwith this method in the relief of contractures on the dorsum and on thepalm of the hand and fingers, and several years ago reported a numberof cases treated bv this method. ^ Fig. 774.—Contracture of the hand following a burn. Duration twenty years.—i and2. Note the limit of extension. The flexion of the little and ring fingers is especially markedand atrophy has occurred. 3. After relief of the contracture a pedunculated flap from theabdominal wall with pedicle above, was implanted. Photograph, (from above), taken twoweeks later and just before the pedicle was cut. The use of the p
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